Measuring Severity of Tinnitus with a Visual Analog

Scale
American Family Physician - Volume 71, Issue 5 (March 2005) - Copyright 2005
American Academy of Family Physicians - About This Journal
Letters to the Editor

Measuring Severity of Tinnitus with a Visual Analog Scale

TO THE EDITOR:

We read with interest the article, Diagnostic Approach to Tinnitus, by Drs.

[1]

Crummer and Hassan in the January 1, 2004, issue of American Family Physician. It
carefully and clearly presented the problem of tinnitus and can be a valuable source of
information for family physicians and their patients. The authors proposed their
[1]

algorithm for a diagnostic approach to patients with tinnitus. We would like to present
our experience in treating patients with this condition.

In the department of Otolaryngology at the Medical University in Gdansk, Poland, as

in most centers that manage patients with tinnitus, one of the most important elements
of diagnostics is history data. Patients classify in a graphic way the pitch and
[2]

loudness of tinnitus using a visual analog scale (see accompanying figure). Our
patients receive questionnaires that assess how troublesome their tinnitus is and its
influence on their daily activity and ability to function. We compare results of the
visual analog scale and the questionnaires before and after treatment, which helps to
objectively assess the therapy results. [3]

Figure . Visual analogue scale of tinnitus.

Figure . Visual analogue scale of tinnitus.

Perhaps the algorithm presented in the article will result in the addition of some new
[1]

elements of objective diagnostics of tinnitus, such as positron emission tomography

(PET) or single photon emission computed tomography. One study using PET in
[4] [5] [6] [4]
 10 patients with tinnitus found increased metabolic activity of the predominant
auditory cortex. Although the patients complained of bilateral tinnitus, the brain
metabolic activity was higher on the left side. Another study investigated four
[4] [6]

patients with continuous unilateral tinnitus, which could be altered by clenching their
jaws. Using PET, the results showed that when the tinnitus was increased in this way
the brain metabolic activity was increased on the opposite side. The study also found
[6] [6]

that the hippocampus was activated in these patients but not in the control subjects.
Hippocampus activation could offer an explanation for the adverse psychologic effects
that patients with tinnitus often experience. The new methods enable physicians to
visualize what previously only had been heard and felt.

Send letters to Jay Siwek, M.D., Editor, American Family Physician, 11400
Tomahawk Creek Pkwy., Leawood, KS 66211-2672; fax: 913-906-6080; e-mail:
afplet@aafp.org.

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Submission of a letter will be construed as granting the AAFP permission to publish
the letter in any of its publications in any form. The editors may edit letters to meet
style and space requirements.

WALDEMAR NAROZNY M.D., PH.D. 1

JERZY KUCZKOWSKI M.D., PH.D. 1

BOGUSLAW MIKASZEWSKI M.D., PH.D. 1

1
Medical University of Gdansk, Department of Otolaryngology, ul. Debinki 7 Gdansk,
POLAND 80-211

REFERENCES

1. Crummer RW, Hassan GA. Diagnostic approach to tinnitus. Am Fam Physician 2004;69:1206. Full Text

2. Tyler
RS, Babin RW. Tinnitus. In: Cummings CW, ed. Otolaryngology Head and Neck Surgery. 2d ed. St.
Louis: Mosby, 1993:303153.

3. Narozny W, Sicko Z, Kuczkowski J, Stankiewicz C, Przewozny T. Usefulness of hyperbaric oxygen therapy

in patients with sensorineural acute and chronic tinnitus. International Congress Series 2003;1240:27786.

4. Arnold
W, Bartenstein P, Oestreicher E, Romer W, Schwaiger M. Focal metabolic activation in the
predominant left auditory cortex in patients suffering from tinnitus: a PET study with [18F] deoxyglucose.
ORL J Otorhinolaryngol Relat Spec 1996;58:1959.
5. JohnsrudeIS, Giraud AL, Frackowiak RS. Functional imaging of the auditory system: the use of positron
emission tomography. Audiol Neurootol 2002;7:25176. Abstract

6. Lockwood AH, Salvi RJ, Coad ML, Towsley ML, Wack DS, Murphy BW. The functional neuroanatomy of
tinnitus: evidence for limbic system links and neural plasticity. Neurology 1998;50:11420. Full Text

Measuring Severity of Tinnitus with a Visual Analog

Scale
American Family Physician - Volume 71, Issue 5 (March 2005) - Copyright 2005
American Academy of Family Physicians - About This Journal
MDC Extra Article: This additional article is not currently cited in MEDLINE, but was
found in MD Consult's full-text literature database.
Letters to the Editor

Measuring Severity of Tinnitus with a Visual Analog Scale

IN REPLY:

Tinnitus is a common symptom that can affect a patients quality of life. There are
many measures to estimate the impact of tinnitus. The visual analogue scale is a
reliable method, commonly used in studies to assess the results of therapy, including
that of hyperbaric oxygen therapy. Positron emission tomography (PET) is a nuclear
[1]

medicine imaging study, used primarily for oncologic staging, which for a number of
years also has been used to investigate tinnitus, along with other objective methods
including auditory brainstem responses and auditory evoked magnetic field. Our [2]

article was written from a primary care point of view. Sophisticated imaging such as
[3]

PET and single photon emission computed tomography were not included in the
algorithm in our article because their relevance in the diagnosis and treatment of
[3]

tinnitus in the primary care setting is still undefined.

RICHARD W. CRUMMER M.D. 501

GHINWA A. HASSAN M.D. 501

State University of New YorkDownstate 450 Clarkson Ave., Box 67 Brooklyn, NY

501

11203

REFERENCES
 1. Narozny W, Sicko Z, Kuczkowski J, Stankiewicz C, Przewozny T. Usefulness of hyperbaric oxygen therapy
in patients with sensorineural acute and chronic tinnitus. International Congress Series 2003;1240:27786.

2. Holgers
KM, Barrenas ML, Svedlund J, Zoger S. Clinical evaluation of tinnitus: a review. Audiological
Medicine 2003;2:1016.

3. Crummer RW, Hassan GA. Diagnostic approach to tinnitus. Am Fam Physician 2004;69:1206. Full Text
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